Asthma Control and Reliever Inhaler Use in Patients Using Short-Acting β2-Agonists

Asthma inhaler
Asthma inhaler
What kinds of patients overuse short-acting β2-agonists, and what kinds of health outcomes are associated with these patients?

A study of pharmacies in Portugal indicated that the asthma population using short-acting β2-agonists (SABA) is largely uncontrolled and uses reliever inhalers excessively.

Results of the observational, cross-sectional, multicenter study were recently published in the Journal of Asthma and Allergy.

Although SABA are usually prescribed to treat episodes of asthma exacerbation, overuse can cause progressive worsening of disease and excessive use may increase the risk for cardiovascular problems, depression, severe exacerbations, and even death.

Researchers in Portugal sought to describe the population using SABA for asthma and examine the patterns of its use among community pharmacy customers as well as identify characteristics associated with disease control and explore potential differences between treatment steps.

The study, conducted over a 2.5-month period in 2018, included 388 patients from 143 pharmacies who completed questionnaires asking for demographic and asthma-related information. Among this patient population, about 50.8% were male, the average age was 52 years old, and half of the patients never smoked.

Notably, more than half of participants reported inhaler overuse, indicating that they had purchased more than 1 SABA cannister over a 3-month period (65.0%) or had used the inhaler on more than 8 days over the previous 4 weeks (50.2%). In addition, 78.7% of patients had poor overall disease control and 79.1% had poorly controlled asthma. Researchers found that the patients reporting SABA overuse were older, had a history of smoking, were retired or unemployed, and had a lower level of education. They also were more likely to have uncontrolled asthma and a history of exacerbation requiring hospitalization.

After categorizing patients according to GINA (Global Initiative for Asthma) treatment steps, the researchers found statistically significant differences between treatment steps in all sociodemographic characteristics, maximum number of SABA uses in 24 hours, self-reported disease control, and history of exacerbations requiring emergency department visits or treatment with oral corticosteroids for at least 3 days in the previous 12 months.

Further analysis found that poor disease control was more likely among patients reporting SABA use for more than 8 days in the previous 4 weeks and in patients with at least 1 exacerbation requiring treatment with oral corticosteroids for at least 3 days in the previous 12 months.

“The results of this study can support the decision makers and the different health professionals in the development of strategies to improve asthma management in Portugal,” concluded the authors.

Disclosure: This research was supported by AstraZeneca, Portugal. Please see the original reference for a full list of disclosures.


Romão M, Godinho AR, Teixeira PM, et al. Characteristics of reliever inhaler users and asthma control: a cross-sectional multicenter study in Portuguese community pharmacies. J Asthma Allergy. 2021;14:943-954. doi:10.2147/JAA.S315678